Provision of Assistance

(a)The MRAO shall develop an eligibility algorithm that will apply to those benefits a resident seeking off-island medical care qualifies for. Residents with commercial health insurance benefits that cover transportation and lodging fees are not eligible for direct assistance from the MRAO. They may, however, qualify for education and coordination assistance.

(b)[No text]

(1)The MRAO shall develop a Health Insurance Portability and Accountability Act (HIPAA) compliant quality improvement program that will consist, at a minimum, of tracking patient issues and resolutions, and a patient satisfaction survey that shall be offered to each patient serviced.

(2)The MRAO or contracted not-for-profit provider shall provide each patient with a brochure explaining the program, and contact information.

(3)The MRAO or contracted not-for-profit provider shall also provide appropriate information of the destination medical facility, transportation organization, lodging facility, and the surrounding area.

(c)[No text]

(1)The MRAO shall develop and maintain reports that include the number of referred patients served, the number of patient escorts or accompanying family members served, and the average cost per patient referral.

(2)The MRAO shall also maintain a monthly report containing the following information:

(A)name of patient;

(B)gender and age of patient;

(C)date of referral;

(D)date assisted;

(E)name of accepting medical facility;

(F)insurance provider;

(G)number of escorts/family members;

(H)departure date; and

(I)service rendered.

(d)In providing assistance to Guam residents, the MRAO shall, to the greatest extent practicable, coordinate with existing services provided by insurance carriers, referring facilities, and local not-for-profit organizations. These services are provided free of charge, and as such may only require verification of availability and notice of services to the resident utilizing the service.

(e)For those residents who are not eligible for existing services provided by health insurance companies, referring facilities, or local not-for-profits, the MRAO may:

(1)develop a request for proposal to provide assistance services from a duly registered Guambased not-for-profit organization that can provide such services, including coordination of appointments, transportation, and lodging. This proposal shall use a voucher type system to provide direct services to residents seeking off-island care. The contracted not-for-profit shall, to the greatest extent possible, coordinate with existing services provided by insurance carriers and referring facilities CH. 1 OFFICE OF I MAGA’HÅGA/MAGA’LÅHI [THE GOVERNOR] for the provision of transportation and lodging services. A limit of fifteen percent (15%) of the negotiated proposal is set for administrative overhead of such proposal; and

(2)provide services through the development of memoranda of understanding or individual contracts with required off-island transportation and lodging organizations to provide transportation and lodging services. The MRAO shall develop internal assistance policies and procedures to guide the operation of the office. This function shall reside within the Guam-based MRAO and is subject to the fifteen percent (15%) administrative overhead of the approved budgeted amount appropriated in I Maga’håga/Maga’låhi’s budget submission for the office.